Download Use of Illicit Psychoactive Substances

The Opioid Replacement
Therapies Review:
Dr Kennedy Roberts
Lead Researcher, ORT Review
Scottish Prison Service College
Polmont 20th. March 2015
The Opioid Replacement
Therapies Review:
….one year on
Dr Brian Kidd
Chair
Drug Strategy Delivery Commission
and
Dr Kennedy Roberts
Lead Researcher, ORT Review
•Methadone- evidence
based
•Suboxone/bup. Evidence
based but dissenters
Not reviewed but
currently important
•Prescribed opioids mainly
for pain
•Abuse of OTC opioids
Plan
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Why was it done?
What did we do?
What did we find?
What does it mean?
What has happened
in a year?
Why was the ORT
review
undertaken?
Progress 1994-1999
- Drug issues
(harm reduction)
“on the map”
- Creation of delivery
system (DATs)
Progress: 1999-2008
- Consolidation and
investment
- Strategic thinking
(e.g. STRADA)
- Delivery system
improvements
Progress from 2008
- Recovery focus
- Outcomes
- Delivery reform
2011 584 deaths
Drivers for review
• Reports of loss of political consensus
• Progress towards delivering recovery
remains elusive despite clear strategy
• Increase in drug deaths continuing
– Methadone implicated in many
• Ongoing negative media reports on
balance, quality of services
Methodology:
how was the ORT
review delivered?
Methodology
• Agreed remit with Minister & Chief Medical
Officer for Scotland
• Lead researchers employed: Dr Kennedy
Roberts and Dr Charles Lind
• Representative Steering Group – drawn from
DSDC and National Drug Death Forum
• Secretariat from Scottish Government
• Aim to deliver “spring 2013”
Remit
Methodology
• A review of the research evidence base on ORT
(focus on methadone)
• Validated review group conclusions with an
international panel of expert reviewers
• Gathered views of Scottish academics on strengths
and weaknesses of the evidence-base in Scotland
• Examined the delivery system in Scotland
– Took evidence from a wide range of stakeholders
• NB Accessibility to the review was paramount
Stakeholders
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Scottish academics
Written and verbal evidence from all ADPs
Relevant government agencies
Politicians
National representative organisations
Health & social care professionals
Residential detox and rehabilitation providers
Those advocating particular therapies/approaches
National and local events
Main findings
5 key themes
• The strong evidence for ORT with methadone – but
the need for quality assurance
• The lack of progress in delivery of recovery outcomes
• The apparent lack of local accountability and postADP integration of the delivery system
• The link with social exclusion and health inequalities
– and need to make this drive access to more generic
services & solutions
• The need for valid information, evaluation and
research
ORT with methadone
• Strong evidence base for effectiveness at
reducing drug-related harms
• Strongest evidence-base for relatively shortterm outcomes (<1year)
• Longer term cohort studies show long-term
protective effect (30+ years)
• Poor evidence base for delivery of “recovery”
with ORT (Bell 2012; Best et al 2010)
• Quality standards and processes essential
Accountability of the delivery system
• The whole system
• How held to account and by what
mechanism?
• Information deficiencies – local and national
• Quality and effectiveness of local partnerships
– Organisational v partnership issues
– Specialist or generalist responses
• Lack of institutional memory
Social exclusion & health inequalities
• Problem substance use a key driver of the “Glasgow
effect” (eg SDF/SAADAT 2007)
– Prevalence mirrors areas of deprivation
– Drug deaths rates mirror areas of deprivation
– Scottish research shows clearly the health impacts
effecting this long term substance users
– Data on social exclusion echoes this
• Need for generic service elements to “own” this
problem and for prioritisation processes to
acknowledge and respond to this anomaly
Information, evaluation & research
Information systems
• Long standing failure to deliver meaningful
national information systems
• Variable local responses
Programme of research for Scotland
• Repeated calls – but limited action to date
• Uniqueness of Scottish dimension – UK
research impact limited
• Opportunity for real, planned change
Recommendations
ORT in Scotland
Delivery of recovery outcomes
Accountability of the delivery system
Social exclusion & health inequalities
Information, evaluation & research
Mechanism for Change
In conclusion
In conclusion
Why was it done?
To address criticisms and concerns regarding
treatment
What did we do?
We comprehensively reviewed the literature.
We took evidence/opinion from a wide range
of Scottish stakeholders
We validated our conclusions via
international experts
In conclusion
What did we find?
We reiterated the link with social
exclusion and health inequalities
We set out the evidence for ORT
We found little evidence of a strong
commitment to recovery at local level
We found the delivery system (from
ADP to DSDC) unable to demonstrate
effectiveness – lack of valid information
In conclusion
What does it mean?
This situation must change
Institutional memory
Consistent action should follow the
evidence-base
Evidence base must develop
Focus on accountability and on
delivering measurable outcomes
Real progress?
…Not as much as hoped… yet